Each of the millions of lines of data managed by Business Operations at Texas Children’s Health Plan are tied to a member or provider – representing a claim or contract processed, a service delivered or a woman or child who received care.
With a real person and real story behind every number, ensuring the files are both accurate and reliable is the first priority for the Provider Data Integrity (PDI) team that recently launched as a joint venture of Business Operations, Contracting and Provider Relations.
Knowing their work touches families and children that need it most keeps the team motivated to master multiple systems, dig into the statistics and use them to paint a bigger picture for our providers, state agencies and other key constituents.
“We are here to take care of our members, to be their voice and to go to bat for them,” said Kellie Malone, director of Business Operations at the Health Plan. “We give everything we have, we’re all in and we’re passionate about what we do.”
Serving on the PDI team is about more than pulling data and compiling reports. These analysts are a critical link between Health Plan members and providers, and a bridge between technically-minded Information Services professionals and businesses that need clear-cut data to function at their best.
What sets PDI team members apart is their skill for seeing data from a different perspective. They are able to draw meaningful conclusions and practical solutions from the numbers, helping to drive smarter decision-making.
“There is a need within operations to be more analytical and connect the dots,” said Jennifer Sima, manager of Provider Experience at the Health Plan, who is also leading the PDI team.
She likens the Health Plan’s function to an insurance company that solely administers Texas Medicaid. Automating processes, maintaining the data in our files and handling claims efficiently all make it easier for our members to access care.
“Making sure our systems are smooth is so important because it directly impacts our members’ lives,” Sima said. “We think about the need, problem-solve and then develop that solution in full. It’s telling the story and telling it logically.”
Though PDI has been initially focused on cleansing the data and building regular controls to ensure it remains trustworthy moving forward, the team will build from that foundation by using the data to track, trend and forecast possible outcomes for Health Plan members. They also plan to conduct more high-level audits and find ways to insert themselves into other areas where their unique approach to data can be useful.
“Our team members take one small bite of data at a time, but with each bite they understand the essence of what we’re doing and how to add value,” Malone said. “We make sure each new person knows that at Texas Children’s and Texas Children’s Health Plan, it’s not about having a job; it’s about having an impact. Everything you do daily makes a difference.”